[Source]

《Pi Wei Lun (1249 AD)》, 《Nei Wai Shang Bian (1249 AD)》 Vol. Zhong.

 [Composition]

Huang Qi, Ren Shen, Zhi Gan Cao, Dang Gui Shen, Chen Pi, Sheng Ma, Chai Hu, Bai Zhu, Sheng Jiang, Da Zao prepared for administration by decocting with ginger and jujube.
(10)

 [Classification Group]

<Blood Tonifying>: Dang Gui Shen

<Qi Regulating>: Chen Pi

<Spleen and Middle Jiao Tonifying>: Bai Zhu, Gan Cao, Da Zao

<Cooling Exterior Releasing>: Chai Hu, Sheng Ma

<Qi Tonifying>: Huang Qi, Ren Shen

<Warming Exterior Releasing>: Sheng Jiang

[Formula Meaning]

《Yi Fang》: Foot Tai Yin Yang Ming herbs.

(1) The Lung is the root of Qi. Huang Qi: Tonifies the Lungs and secures the exterior, acting as the monarch.

(2) The Spleen is the root of the Lung. Ren Shen, Gan Cao: Tonify the Spleen, benefit Qi, harmonize the Middle Jiao, and purge fire, acting as ministers. (Dong Yuan stated: Ren Shen, Huang Qi, and Gan Cao are supreme herbs for purging fire. This is because prolonged overwork leads to deficiency and heat. They receive the sweet warmth to tonify primordial Qi, and the deficiency heat recedes on its own, thus they are also called fire-purging.)

(3) Bai Zhu: Dries dampness and strengthens the Spleen.

(4) Dang Gui: Harmonizes blood and nourishes Yin, acting as an assistant.

(5) Sheng Ma: Ascends the clear Qi of the Yang Ming.

(6) Chai Hu: Ascends the clear Qi of the Shao Yang. When Yang ascends, all things are born; when the clear Qi ascends, the turbid Yin descends.

(7) Adding Chen Pi: To facilitate the flow of Qi.

(8) Sheng Jiang: Pungent and warm. Da Zao: Sweet and warm. Used to harmonize the Ying and Wei, open the pores, and induce bodily fluids for various deficiencies.

(9) First establish the Middle Jiao. What is the Middle Jiao? It is the Spleen and Stomach. 《Shan Bu》: Ke Qin stated: Zhong Jing has Jian Zhong and Li Zhong methods. Wood-wind internally dries the Middle Jiao Qi, so Gan Cao, maltose, and jujubes are used to cultivate the Earth to ward off wood; ginger, cinnamon, and peony are used to pacify wood and expel wind, hence the name Jian Zhong.

Cold water internally congeals in the Middle Jiao Qi, so Ren Shen, Bai Zhu, and Gan Cao are used to tonify Earth to control water, assisted by dried ginger to generate Earth to ward off cold, hence the name Li Zhong. As for fatigue and emaciation, Qi deficiency, Yin deficiency leading to internal heat, the exterior signs are quite similar to exogenous pathogenic factors. Only Li Gao knew it was due to fatigue damaging the Spleen, and that grain Qi could not overcome Yang Qi, causing it to sink into the Yin and generate heat.

The formulated the method of Bu Zhong Yi Qi, stating that wind and cold externally damage the form, which is an excess; internal damage to Qi by the Spleen and Stomach is a deficiency. Following the principle of “warm that which is cold, benefit that which is deficient” from the 《Nei Jing》, bitter-cold herbs are strictly avoided, and sweet-warm ingredients are selected to elevate Yang, to achieve the command of Yang’s ascending and generating. When the Spleen and Stomach are deficient, Lung Qi is the first to disappear, so Huang Qi is used to protect the skin and hair and close the pores, preventing spontaneous sweating.

For insufficient primordial Qi, laziness to speak, and shortness of breath, Ren Shen is used to tonify it. The sweetness of charred Gan Cao is used to purge heart fire and relieve vexation, and to tonify the Spleen and Stomach and generate Qi. These three herbs are supreme for purging vexing heat. Assisted by Bai Zhu to strengthen the Spleen, and Dang Gui to harmonize blood. When Qi is disturbed in the chest, clear and turbid Qi are in conflict, Chen Pi is used to regulate it, and also to disperse the stagnation of the sweet herbs. When clear Qi of the Stomach sinks, Sheng Ma and Chai Hu, which are light in Qi and thin in flavor, are used to guide the Stomach Qi upwards and restore its original position, enabling it to ascend and float, to carry out the command of generating and growth.

A formula for tonifying the Middle Jiao, when combined with exterior-releasing herbs, ensures the Middle Jiao is peaceful; a formula for benefiting Qi, relies on clear Qi-acting herbs to further cultivate Qi. This demonstrates the wonderful synergy of herbs. This formula is used to tonify the Spleen, causing the earthly path to ascend. It can also tonify the Heart and Lungs; for those with damaged Lungs, it benefits their Qi; for those with damaged Hearts, it harmonizes their Ying and Wei. It can also tonify the Liver wood; when it is depressed, it is dispelled. However, it is not suitable for the Kidneys; those with Yin deficiency in the lower Jiao should not ascend, and those with Yang deficiency in the lower Jiao should even less ascend. Li Gao’s formulas for the Spleen and Stomach are all for benefiting Qi.

If Dang Gui and Bai Zhu are removed and Cang Zhu and Mu Xiang are added, it becomes Tiao Zhong. If Mai Dong and Wu Wei Zi are added, it becomes Qing Shu. This is indeed the case where medicine does not rigidly adhere to formulas, but also that medicine must have a formula. Zhao Xian Ke stated: Post-natal Spleen Earth cannot function without pre-natal Qi. This Qi has sunk into the Tai Yin due to labor, causing clear Qi to not ascend and turbid Qi to not descend. Therefore, Sheng Ma and Chai Hu are used to assist Ren Shen and Huang Qi. This formula therefore tonifies the pre-natal within the post-natal.

For those with Spleen and Stomach deficiency, they prefer sweetness and dislike bitterness, prefer tonifying and dislike attacking, prefer warmth and dislike cold, prefer smooth flow and dislike stagnation, prefer ascending and dislike descending, prefer dryness and dislike dampness. This formula achieves these goals. Lu Li Jing stated: This formula is for those with descending clear Yang, not for those with deficiency in the lower Jiao and ascending clear Yang. If one’s lower Jiao is deficient, either the Kidney water is exhausted or the Ming Men fire has declined. If there is further upward lifting, it is like a large tree about to fall being uprooted.

《Han Dian》: Ren Shen, Bai Zhu, Chen Pi, and Gan Cao have the effect of strengthening the stomach and fortifying. Huang Qi and Dang Gui enhance the nourishment of the skin and treat night sweats. Chai Hu and Sheng Ma have the effect of detoxifying. Sheng Jiang and Da Zao harmonize the various herbs and enhance their medicinal power.

 [Function]

Tonifies the Middle Jiao and benefits Qi, harmonizes and tonifies the Spleen and Stomach, ascends Yang, benefits Qi, and lifts that which has sunk.

 [Indications]

(1) Spleen and Stomach Qi deficiency with sinking of the Middle Jiao Qi, manifesting as fever and spontaneous sweating, thirst with a preference for warm drinks, headache and aversion to cold, lassitude in speaking and lack of energy, tasteless food, weakness of the four limbs, pale and tender tongue, and a deep, large pulse. (2) Or symptoms due to deficiency of Qi causing clear Yang to sink, such as rectal prolapse, uterine prolapse, chronic dysentery, or chronic malaria. (3) This formula is applicable in situations where Xiao Chai Hu Tang might be considered, but it is used for those who are easily fatigued and have poor abdominal elasticity. It is suitable for those with a weak pulse, tired limbs, weak speech and gaze, or mild fever, poor appetite, night sweats, and pulsating discomfort in the umbilical region. 《Yi Fang》: (1) Treats vexation and internal injury, with body fever, vexation, headache and aversion to cold, laziness to speak, poor appetite, and a forceful but deficient pulse. (2) May have shortness of breath or thirst, or Yang deficiency with spontaneous sweating, or Qi deficiency unable to astringe blood. Or malaria, dysentery, and Spleen deficiency that does not heal for a long time. (3) All conditions of sinking clear Yang, deficiency of Middle Jiao Qi. 《Shan Bu》: Internal heat due to Yin deficiency, headache, thirst, exterior heat with spontaneous sweating, intolerance to wind and cold, forceful pulse, restless mind, weary limbs, lazy to speak, lack of energy for movement, and shortness of breath with exertion.

 [Indications]

(1) Post-illness recovery, improvement of weak constitution, gastroptosis, loss of appetite, gastric atony, peptic ulcer, uterine prolapse, myasthenia gravis, chronic diarrhea, uterine bleeding, leukorrhea, etc. (2) Chronic hepatitis, hypotension, insomnia, pleurisy, tuberculosis, enteritis, chyluria, insomnia, tinnitus, hiccups, depression, rectal prolapse, uterine prolapse, general debility, impotence, hemiplegia, hyperhidrosis, etc.

 [Contraindications]

(1) Contraindicated for those with deficiency in the lower Jiao; to be avoided by those with excessive Yin and internal heat. (2) Caution should be exercised if the illness is severe and the heat symptoms are of an aggressive nature.

 [Mnemonics]

Si Jun without Ling, Sheng Chai Gui as its ministers + three assistants (Bai Ren Gan, Sheng Chai Gui Qi Chen + Gan Jiang Zao).

 [Modifications]

《Yi Fang》: (1) If blood is deficient: add Dang Gui.

(2) If spirit is depleted: add Ren Shen, Wu Wei Zi.

(3) For lung heat with cough: remove Ren Shen.

(4) If thirsty: add Ge Gen.

(5) For headache: add Man Jing Zi; for severe pain, add Chuan Xiong.

(6) For brain pain: add Gao Ben, Xi Xin.

(7) For wind-damp obstruction with pain throughout the body: add Qiang Huo, Fang Feng.

(8) If there is phlegm: add Ban Xia, Sheng Jiang.

(9) For stomach cold with Qi stagnation: add Qing Pi, Kou Ren, Mu Xiang, Yi Zhi Ren.

(10) For abdominal distention: add Zhi Shi, Hou Po, Mu Xiang, Sha Ren Sha Ren.

(11) For abdominal pain: add Bai Shao, Gan Cao.

(12) For painful heat: add Huang Lian. If one can eat but has epigastric fullness: add Huang Lian. (13) For sore throat: add Jie Geng.

(14) If there is cold: add Rou Gui.

(15) If dampness predominates: add Cang Zhu.

(16) For Yin fire: add Huang Bai, Zhi Mu.

(17) For Yin deficiency: remove Sheng Ma and Chai Hu, add Shu Di Huang, Shan Zhu Yu, Shan Yao.

(18) For constipation: add wine-fried Da Huang.

(19) Cough: Spring: add Xuan Fu Hua, Kuan Dong Hua; Summer: add Mai Dong, Wu Wei Zi; Autumn: add Ma Huang, Huang Qin; Winter: add Ma Huang with roots and nodes removed; Cold weather: add Gan Jiang.

(20) For diarrhea: remove Dang Gui, add Fu Ling, Cang Zhu, Yi Zhi Ren. 《Han Dian》: If there is cough in cases of pulmonary tuberculosis, add Wu Wei Zi and Mai Men Dong; this is called Mai Wei Yi Qi Tang.

If used for chronic rectal prolapse, add Chi Shi Zhi; this is called Chi Shi Zhi Tang.

(1) If accompanied by chyluria, Huang Qin should be added to clear lung heat, and Bi Xie should be used in large doses to separate the clear from the turbid.

(2) If there is uterine bleeding, Xian He Cao should be added to stop bleeding.

(3) If accompanied by chronic dysentery, Mu Xiang and Huang Lian should be added to regulate Qi stagnation and resolve damp-heat.

(4) If accompanied by leukorrhea, Che Qian Zi and the white bark of the Chinese toon tree should be added to promote urination, remove dampness, clear heat, and dry dampness.

(5) If accompanied by uterine bleeding, Huang Qin Tan, Xian He Cao, and cuttlefish bone should be added to clear heat and stop bleeding.

(6) For Qi deficiency headache, Man Jing Zi and Chuan Xiong should be added to relieve pain.

(7) For pain in the head or a hollow sensation in the head, add Gao Ben, Xi Xin, and Wu Zhu Yu to relieve pain.

(8) For chronic diarrhea, add Rou Dou Kou and Yi Zhi Ren to astringe and stop diarrhea.

(9) For deficiency in the Middle Jiao with abdominal pain, add Bai Shao Yao, Wu Zhu Yu, and Wu Yao to relieve pain.

(10) If Gan Cao, Ren Shen, Dang Gui, Chen Pi, and Bai Zhu are removed from this formula, and Zhi Mu and Jie Geng are added, it becomes Sheng Xian Tang 《Yi Xue Zhong Zhong Can Xi Lu》, which benefits Qi and lifts that which has sunk, treating symptoms of severe Qi sinking. Symptoms include shortness of breath, difficulty breathing, or labored breathing resembling asthma, or imminent respiratory arrest, with a deep, slow, weak pulse, or irregular pulse.

(11) If there is limb swelling, pain, and low-grade fever after injury, this formula should be applied with modifications.

(12) If accompanied by spontaneous sweating, Mu Li San Mu Li San should be added to astringe Yin and stop sweating.

 [Pharmacology]

Regulates gastrointestinal motility, protects against gastric ulcers and mucosal damage, stimulates the uterus, enhances myocardial contractility, affects digestive secretions, modulates immune function, promotes metabolism, and has anti-tumor and anti-mutagenic effects. It has a selective excitatory effect on the uterus and surrounding tissues in vivo and in vitro. It can improve the body’s protein metabolism, prevent the development of anemia, and enhance physical strength.